Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department

Intensive Care Med. 2013 Jul;39(7):1290-8. doi: 10.1007/s00134-013-2919-7. Epub 2013 Apr 13.


Purpose: We analyzed the efficacy of a point-of-care ultrasonographic protocol, based on a focused multiorgan examination, for the diagnostic process of symptomatic, non-traumatic hypotensive patients in the emergency department.

Methods: We prospectively enrolled 108 adult patients complaining of non-traumatic symptomatic hypotension of uncertain etiology. Patients received immediate point-of-care ultrasonography to determine cardiac function and right/left ventricle diameter rate, inferior vena cava diameter and collapsibility, pulmonary congestion, consolidations and sliding, abdominal free fluid and aortic aneurysm, and leg vein thrombosis. The organ-oriented diagnoses were combined to formulate an ultrasonographic hypothesis of the cause of hemodynamic instability. The ultrasonographic diagnosis was then compared with a final clinical diagnosis obtained by agreement of three independent expert physicians who performed a retrospective hospital chart review of each case.

Results: Considering the whole population, concordance between the point-of-care ultrasonography diagnosis and the final clinical diagnosis was interpreted as good, with Cohen's k = 0.710 (95 % CI, 0.614-0.806), p < 0.0001 and raw agreement (Ra) = 0.768. By eliminating the 13 cases where the final clinical diagnosis was not agreed upon (indefinite), the concordance increased to almost perfect, with k = 0.971 (95 % CI, 0.932-1.000), p < 0.0001 and Ra = 0.978.

Conclusions: Emergency diagnostic judgments guided by point-of-care multiorgan ultrasonography in patients presenting with undifferentiated hypotension significantly agreed with a final clinical diagnosis obtained by retrospective chart review. The integration of an ultrasonographic multiorgan protocol in the diagnostic process of undifferentiated hypotension has great potential in guiding the first-line therapeutic approach.

MeSH terms

  • Abdomen / diagnostic imaging
  • Adult
  • Aged
  • Aged, 80 and over
  • Echocardiography
  • Emergencies
  • Female
  • Humans
  • Hypotension / diagnostic imaging*
  • Hypotension / etiology*
  • Italy
  • Lung / diagnostic imaging
  • Male
  • Middle Aged
  • Point-of-Care Systems*
  • Prospective Studies
  • Retrospective Studies
  • Shock / diagnostic imaging*
  • Shock / etiology*
  • Veins / diagnostic imaging